The Consumption Cure

Sir, — It may, perhaps, be not entirely out of place for an English
physician who has had good opportunities of seeing the recent
development of the treatment for tuberculosis in Berlin to say
something as to its present position and probable results. Great as
is Koch's discovery, there can be no question that our knowledge
of it is still very incomplete, and that it leaves large issues open to
question. The sooner that this is recognised the less chance will
there be of serious disappointment among those who are looking to
Berlin for a panacea for their own or their friends' ill-health.
I have seen the cases under Professor Bergmann's treatment,
those under Professor Bardeleben at the Charite Hospitul, and
those of Dr. Levy at his Clinical Cluss, in the Prentzlauer Strasse.
This series of cases, taken together with the observations of the
assistant physicians and students who have seen most of the
treatment, enables one to form some opinion, however imperfect,
as to the weaker and stronger points of the system.

In the first place, as to the obtaining of the all-important lymph.
I called upon Dr. A. Libbertz, to whom its distribution had been
entrusted, and I learned that the present supply is insufficient to
meet the demands of the German hospitals, and that it will be at
least six weeks before any other demands could be supplied. A pile
of letters upon the floor 4ft across and as high as a man's knee gave
some indication of what the future demand would be. These, I was
informed, represented a single post.

Now as to what may fairly be expected from the lymph when
this initial difficulty has been got over. It must never be lost sight
of that Koch has never claimed that his fluid kills the tubercle
bacillus. On the contrary, it has no effect upon it, but destroys the
low form of tissue in the meshes of which the bacilli lie. Should this
tissue slough in the case of lupus, or be expelled in the sputum in
the case of phthisis, and should it contain in its meshes all the
bacilli, then it would be possible to hope for a complete cure.
When one considers, however, the number and the minute size of
these deadly organisms, and the evidence that the lymphatics as
well as the organs are affected by them, it is evident that it will only
be in very exceptional cases that the bacilli are all expelled. By the
cessation of the reaction after injection you can tell when the
tubercular tissue is all cleared out from the system, but there is no
means by which you can tell how far the bacilli have also been gt
rid of. If any remain they will, of course, cause by their irritation
fresh tubercular tissue to form, which in turn may be destroyed by
a new series of injections. But, unfortunately, it is evident that the
system soon establishes a tolerance to the injected fluid, so that the
time must, apparently, come when the continually renewed
tubercle tissue will refuse to respond to the remedy, in whatever
strength it may be applied. Here lies the vast difference between
Koch's treatment of consumption and the action of vaccine in the
case of smallpox. The one is (for a time at least) conclusive, while
in the other your remedy does not touch the real seat of the evil. To
use a homely illustration, it is as if a man whose house was infested
with rats were to remove the marks of the creatures every morning
and expect in that way to get rid of them. Professor Koch himself
admits that the bacillus is untouched, and there has not been time
yet to see how far its presence will re-establish the old state of
things. There is, however, grave reason to fear that it may at least
possibly have the effect which I indicate.

Another objection — though a much slighter one — is that the
process stirs into activity all those tubercular processes which
have become dormant. In one case which I have seen the injection,
given for the cure of a tubercular joint, caused an ulcer of the
cornea, which had been healed for twenty years, to suddenly break
out again, thus demonstrating that the original ulcer came from a
tubercular cause. No doubt the ultimate effect of the injection
would be beneficial to the corneal ulcer, as well as to the joint, but
it is none the less somewhat trying to the patient to have all his
varied ailments brought to a head simultaneously. It may also be
remarked that the fever and reaction after the injection is in some
cases so very high (41° Centigrade, or over 108° Fahr.) that it is
hardly safe to use it in the case of a debilitated patient.
So much as to the more obviously weak points of the system.
Others may develop themselves as more experience is gained. On
the other hand, its virtues are many, and it represents an entirely
new departure in medicine. There can be no question that it forms
an admirable aid to diagnosis. Tubercle, and tubercle alone
responds to its action, so that in all cases where the exact nature of a
complaint is doubtful a single injection is enough to determine
whether it is lupus, scrofula, phthisis, or any of the manifold forms,
of tubercle. This alone is a very important addition to the art of
medicine.

Lupus and joint affections (scrofulous) undoubtedly get great
benefit, but Koch himself cannot tell how far this is temporary and
how far permanent. In the early stages of phthisis, again, it causes
a rapid change for the better. When cavities are formed, however,
Koch himself says that the aid of the surgeon should be employed,
which means an extensive and serious operation.

Whatever may be thought of the system, there can be but one
opinion as to the man himself. With the noble modesty which is his
characteristic, he has retired from every public demonstration.
Leaving other own to expound his views, he immures himself once
more in his laboratory, and I can say from experience that it is
impossible for the stranger in Berlin to see the man whom, of all
others, he would most wish to meet.

I hope that perhaps these remarks may be of some practical
value to those of your readers who may have some personal reason
for desiring to know exactly what is thought in Berlin of the recent
discovery. — I am, Sir, your obedient servant,